Melatonin for Fibromyalgia

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Melatonin is a hormone that naturally occurs in the body and helps to regulate sleep-wake cycles. It can also be produced synthetically and taken as a dietary supplement. Darkness causes the body to naturally produce more melatonin, which then sends signals to the brain and through the body that it is time to sleep. Conversely, daylight causes melatonin levels to decrease and prepares the body to awaken. Many individuals who experience sleep disturbances or difficulties have low levels of melatonin and it is believed that supplementing the body’s natural supply of the hormone may help improve their sleep.

Melatonin has been used for a number of sleep-related purposes, including regulating sleep-wake cycles, recovery from jet lag, adjusting sleep-wake cycles in individuals who have fluctuations in daily work schedules, and treating insomnia. Apart from sleep-related uses, melatonin has also been used for a number of other conditions, including Alzheimer’s disease, tinnitus (ringing in the ears), depression, chronic fatigue syndrome, migraine headaches, fibromyalgia, irritable bowel syndrome, and others. Dosages of the supplement vary according to the indication for which it is used, but generally range from 0.3 to 5mg.

Possible Risks and Drug Interactions

 Melatonin is likely safe, but it does occasionally cause some side effects including headache, depression, excessive daytime sleepiness, dizziness, stomach cramps, and irritability. It may be unsafe during pregnancy, however, so pregnant and nursing women should not use it. Melatonin may also interfere with a woman’s ability to ovulate and become pregnant. Since melatonin is a hormone, it should not be used in children as it may interfere with adolescent development. Individuals with high blood pressure should avoid using melatonin as it can result in further increases in blood pressure. It can also raise blood sugar levels, so individuals who have diabetes should carefully monitor their blood sugar levels while taking melatonin. Finally, individuals with depression may notice worsening symptoms if they take melatonin, and those with seizure disorders may experience an increased risk of seizures.

Since melatonin may cause drowsiness and sleepiness, it should not be taken alongside certain sedative medications, examples of which include Klonopin, Ativan, and Ambien. In addition, birth controls pills increase the amount of melatonin the body produces, therefore concurrently taking melatonin may cause excessive levels of melatonin in the body. Caffeine may decrease the effectiveness of melatonin supplements, as caffeine causes melatonin levels to decrease. The antidepressant drug Luvox may increase melatonin levels in the body, as well as increase the effects and side effects of melatonin supplements. Individuals who take medications for diabetes, immune system disorders, and blood clotting should use caution when taking melatonin, as it may also decrease the effectiveness of these medications.

With regard to natural therapies, melatonin may increase the potency of certain herbs that slow blood clotting and therefore increase the risk of bleeding in certain individuals. Examples of these herbs include willow, red clover, Panax ginseng, ginkgo, ginger, clove, and angelica. Similarly, melatonin may also increase the potency of herbs and supplements that have sedative effects, including 5-HTP, California poppy, catnip, Jamaican dogwood, kava, St. John’s wort, skullcap, valerian, and yerba mansa.

Melatonin for Fibromyalgia

 One small study suggested that fibromyalgia patients may have lower levels of melatonin during dark hours and theorized that these reduced levels of melatonin may in fact contribute to the sleep disturbances commonly experienced by fibromyalgia patients (Wikner et al., 1998). A more recent study has also made similar suggestions and has even suggested that disruptions in the sleep-wake cycle may affect not only the treatment of fibromyalgia, but also have an impact on its development and diagnosis (Mahdi et al., 2011). A 2000 study by Citera et al. investigated effects of melatonin on pain, sleep disturbances, fatigue, depression, anxiety, and overall ability to function in 21 patients with fibromyalgia. The researchers found that the patients’ tender point counts and sleep quality both improved. However, this study was limited in design and as such, the researchers noted the need for additional studies to examine the relationships between melatonin, sleep and fibromyalgia.

Melatonin has also been investigated in a number of conditions that frequently occur alongside fibromyalgia, including sleep-wake cycle disturbances, insomnia, irritable bowel syndrome, chronic fatigue syndrome, and depression. Among these conditions, the most concrete evidence exists to support the use of melatonin to treat sleep-wake cycle disturbances (Dolberg et al., 1998; Brusco et al., 1999), although a majority of the studies in this niche have been conducted in children and adolescents with mental and developmental problems and certain disorders of the central nervous system (Lancioni et al., 1999; O’Callaghan et al., 1999; Jan et al. 1999). As such, the findings may or may not be applicable to other populations. There is some evidence to suggest that melatonin is useful in treating insomnia, by decreasing the time it takes individuals to fall asleep, however the findings have not been terribly profound and more evidence is needed (Ellis et al., 1996; James et al., 1990; Buscemi et al., 2004; Buscemi et al., 2005). With regard to depression, melatonin has been shown to be likely ineffective in treating the outward symptoms of depression, and some research has suggested that the hormone may actually make depressive symptoms worse (Dolberg et al., 1998; Carman et al. 1976; Leibenluft et al., 1997). Studies evaluating the effectiveness of melatonin to treat sleep disturbances associated with chronic fatigue syndrome have provided mixed results (van Heukelom et al., 2006; Williams et al., 2002). Finally, in individuals with irritable bowel syndrome, melatonin has been shown to decrease abdominal pain, however it has not been shown to influence bloating, mood, sleep, or overall quality of life (Song et al., 2005).

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References

1.        Citera G, Arias MA, Maldonado-Cocco JA, Lazaro MA, Rosemffet MG, Brusco LI, Scheines EJ, Cardinalli DP. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol. 2000;19(1):9-13.

2.        Wikner J, Hirsch U, Wetterberg L, Rojdmark S. Fibromyalgia – a syndrome associated with decreased nocturnal melatonin secretion. Clin Endocrinol (Oxf). 1998;49(2):179-183.

3.        Lancioni GE, O’Reilly MF, Basili G. Review of strategies for treating sleep problems in persons with severe or profound mental retardation or multiple handicaps. Am J Ment Retard. 1999;104:170-186.

4.        O’Callaghan FJ, Clarke AA, Hancock E, et al. Use of melatonin to treat sleep disorders in tuberous sclerosis. Dev Med Child Neurol. 1999;41:123-126.

5.        Jan JE, Freeman RD, Fast DK. Melatonin treatment of sleep-wake cycle disorders in children and adolescents. Dev Med Child Neurol. 1999;41:491-500.

6.        Dolberg OT, Hirschmann S, Grunhaus L. Melatonin for the treatment of sleep disturbances in major depressive disorder. Am J Psychiatr. 1998;155:1119-1121.

7.        Brusco LI, Fainstein I, Marquez M, Cardinali DP. Effect of melatonin in selected populations of sleep-disturbed patients. Biol Signals Recept. 1999;8:126-131.

8.        Ellis CM, Lemmens G, Parkes JD. Melatonin and insomnia. J Sleep Res. 1996;5:61-65.

9.        James SP, Sack DA, Rosenthal NE, Mendelson WB. Melatonin administration in insomnia. Neuropsychopharmacology. 1990;3:19-23.

10.     Buscemi N, Vandermeer B, Pandya R, et al. Melatonin for treatment of sleep disorders. Summary, Evidence Report/Technology Assessment #108. (Prepared by the Univ of Alberta Evidence-based Practice Center, under Contract#290-02-0023.) AHRQ Publ #05-E002-2. Rockville, MD: Agency for Healthcare Research & Quality. November 2004.

11.     Buscemi N, Vandermeer B, Hooton N, et al. The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis. J Gen Intern Med. 2005;20:1151-1158.

12.     Carman JS, Post RM, Buswell R, et al. Negative effects of melatonin on depression. Am J Psychiatry. 1976;133:1181-1186.

13.     Leibenluft E, Feldman-Naim S, Turner EH, et al. Effects of exogenous melatonin administration and withdrawal in five patients with rapid-cycling bipolar disorder. J Clin Psychiatry. 1997;58:383-388.

14.     van Heukelom RO, Prins JB, Smits MG, Bleijenberg G. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol. 2006;13:55-60.

15.     Williams G, Waterhouse J, Mugarza J, et al. Therapy of circadian rhythm disorders in chronic fatigue syndrome: no symptomatic improvement with melatonin or phototherapy. Eur J Clin Invest. 2002;32:831-837.

16.     Song GH, Leng PH, Gwee KA, et al. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised double blind placebo controlled study. Gut. 2005;54:1402-1407.

Mahdi AA, Fatima G, Das SK, Verma NS. Abnormality of circadian rhythm of serum melatonin and other biochemical parameters in fibromyalgia syndrome. Indian J Biochem Biophys. 2011;48(2):82-87.

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